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/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/name-98198-en.cckm

201708216

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UWHC,UWMF,

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Hospital-wide

IP – Diabetes Discharge Supplies – Adult – Supplemental [4797]

IP – Diabetes Discharge Supplies – Adult – Supplemental [4797] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP - Diabetes Discharge Supplies - Adult - Supplemental [4797]
Medications
Insulin - Rapid Acting [134260]
insulin lispro (human) (HUMALOG) 100 UNIT/ML
injection [53264]
1 Vial, 5, starting 8/1/17, Normal
Insulin Lispro (Human) (HUMALOG KWIKPEN)
100 UNIT/ML soln pen-injector [162942]
15 mL, 5, starting 8/1/17, Normal
insulin aspart (NOVOLOG) 100 UNIT/ML injection
[65110]
1 Vial, 5, starting 8/1/17, Normal
insulin aspart (NOVOLOG FLEXPEN) 100
UNIT/ML soln pen-injector [162936]
15 mL, 5, starting 8/1/17, Normal
Insulin Glulisine (APIDRA) 100 UNIT/ML injection
[126042]
1 Vial, 5, starting 8/1/17, Normal
insulin glulisine (APIDRA SOLOSTAR) 100
UNIT/ML soln pen-injector [162940]
15 mL, 5, starting 8/1/17, Normal
Insulin - Short Acting [134261]
insulin regular (human) 100 UNIT/ML injection
[45422]
1 Vial, 5, starting 8/1/17, Normal
Insulin - Intermediate Acting [134262]
insulin isophane NPH (human) (HUMULIN N) 100
UNIT/ML injection susp [45417]
1 Vial, 5, starting 8/1/17, Normal
insulin isophane NPH (human) (HUMULIN N
KWIKPEN) 100 UNIT/ML susp pen-injector
[162945]
15 mL, 5, starting 8/1/17, Normal
Insulin - Long Acting [134264]
insulin glargine (LANTUS) 100 UNIT/ML injection
[64829]
1 Vial, 5, starting 8/1/17, Normal
insulin glargine (LANTUS SOLOSTAR) 100
UNIT/ML soln pen-injector [162938]
15 mL, 5, starting 8/1/17, Normal
BASAGLAR KWIKPEN 100 UNIT/ML soln pen-
injector [174529]
15 mL, 5, DAW, starting 8/1/17, Normal
insulin detemir (LEVEMIR) 100 UNIT/ML injection
[112060]
1 Vial, 5, starting 8/1/17, Normal
LEVEMIR FLEXPEN 100 UNIT/ML soln pen-
injector [163333]
15 mL, 5, DAW, starting 8/1/17, Normal
insulin degludec (TRESIBA FLEXTOUCH) 100
UNIT/ML solution pen injector [169506]
15 mL, 5, starting 8/1/17, Normal
Combination Insulin [202969]
insulin isophane NPH-regular (human) (HUMULIN
KWIKPEN) (70-30) 100 UNIT/ML susp pen-
injector [162949]
starting 8/1/17, Normal
insulin isophane NPH-regular (human) (70-30)
100 units/mL vial [45419]
starting 8/1/17, Normal
insulin lispro protamine-insulin lispro (HUMALOG
MIX KWIKPEN) (75-25) 100 UNIT/ML susp pen-
injector [162947]
starting 8/1/17, Normal
insulin lispro protamine-insulin lispro (HUMALOG
MIX) (75-25) 100 UNIT/ML injection susp
[112471]
starting 8/1/17, Normal
insulin aspart protamine-insulin aspart
(NOVOLOG MIX FLEXPEN) (70-30) 100
UNIT/ML susp pen-injector [162946]
starting 8/1/17, Normal
insulin aspart protamine-insulin aspart
(NOVOLOG MIX) (70-30) 100 UNIT/ML injection
susp [70519]
starting 8/1/17, Normal
Glucagon [137491]
Page 1 of 6
Printed by SPENCER, LINDSEY M [LMS033] at 8/1/2017 5:26:27 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

glucagon (GLUCAGEN) 1 MG injection kit [61223] 1 mg, 2 each, 5, starting 8/1/17, Normal
Supplies
Syringes [134265]
All w/QTY of 200. Click on link below supply to change QTY.
Insulin Syringe 29G X 1/2" 1 ML MISC [52941] 200 each, 5, starting 8/1/17, Normal
Insulin Syringe 31g X 5/16" 0.3 mL [70948] 200 each, 5, starting 8/1/17, Normal
Insulin Syringe 31g X 5/16" 0.5 mL [70949] 200 each, 5, starting 8/1/17, Normal
Insulin Syringe 31g X 5/16" 1 mL [70947] 200 each, 5, starting 8/1/17, Normal
Pen Needles [137494]
All w/QTY of 200. Click on link below supply to change QTY.
Insulin Pen Needle 32G X 4 MM MISC [140836] 200 each, 5, starting 8/1/17, Normal
Insulin Pen Needle 31G X 5 MM MISC [103986] 200 each, 5, starting 8/1/17, Normal
Insulin Pen Needle 31G X 8 MM MISC [103988] 200 each, 5, starting 8/1/17, Normal
Test strips and lancets must be specific to patient's meter and insurance [223790]
Verio Flex OR One Touch Verio Meter [202324]
Glucose Blood (ONETOUCH VERIO) STRP
[64259]
150 Strip, 11, starting 8/1/17, Normal
ONETOUCH DELICA LANCETS 33G MISC
[159866]
200 each, 11, starting 8/1/17, Normal
Test strips and lancets must be specific to patient's meter and insurance [223792]
Accuchek-Guide Meter [139219]
Glucose Blood (ACCU-CHEK GUIDE) STRP
[64259]
150 Strip, 11, starting 8/1/17, Normal
Dispense Accuchek Guide Glucose Test Strips
ACCU-CHEK FASTCLIX LANCETS MISC
[148813]
200 each, 11, starting 8/1/17, Normal
Test strips and lancets must be specific to patient's meter and insurance [223795]
Freestyle Lite Meter [139198]
Glucose Blood (FREESTYLE LITE TEST) STRP
[64259]
150 Strip, 11, starting 8/1/17, Normal
Test blood glucose up to 4 times daily as directed by
physician
FreeStyle Lancets MISC [64865] 200 each, 11, starting 8/1/17, Normal
Test strips and lancets must be specific to patient's meter and insurance [223797]
Bayer Contour Next One [222081]
Glucose Blood (BAYER CONTOUR NEXT TEST)
STRP [64259]
150 Strip, 11, starting 8/1/17, Normal
Test blood glucose up to 4 times daily as directed by
physician
BAYER MICROLET LANCETS MISC [57493] 200 each, 11, starting 8/1/17, Normal
Test strips and lancets must be specific to patient's meter and insurance [222082]
Precision Xtra Supplies [222084]
Glucose Blood STRP [64259] 150 Strip, 5, starting 8/1/17, Normal
Dispense Precision Xtra Blood Glucose in Vitro Strip
Blood Glucose Monitoring Suppl SUPPLIES
MISC [54795]
200 each, 5, starting 8/1/17, Normal
Test strips and lancets must be specific to patient's meter and insurance [222078]
Generic Supplies [222079]
Blood Glucose Test Strips [54795] 150 each, 5, starting 8/1/17, Normal
Lancets [54795] 200 each, 5, starting 8/1/17, Normal
Acetone (Urine) Test Strips [137505]
Acetone (Urine) Test (KETOSTIX) STRP [64253] 1 each, 5, starting 8/1/17, Normal
Diabetes Care Instructions
Diabetes Care [192619]
Page 2 of 6
Printed by SPENCER, LINDSEY M [LMS033] at 8/1/2017 5:26:27 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Diabetes Care Instructions [NURCOM0112] Routine, - Your blood sugar goal range before meals
is *** mg/dL.
- Monitor your blood sugar {UWIP Glucose Monitoring
Frequency:23755}.
- Your blood sugar should be 100 mg/dL or higher
before driving, exercise and at bedtime.
- If your blood sugars are uncontrolled after you leave
the hospital, contact your provider who manages your
diabetes. Your medicine doses may need to be
changed.
- UNCONTROLLED blood sugars mean:
- Blood sugar above 150 mg/dL more than half the
time during a week.
- Blood sugar over *** mg/dL.
- Blood sugar less than 70 mg/dL two or more times
per week (or if having signs/symptoms of low blood
sugar such as shaking, sweating, or light-
headedness).
- To learn more about diabetes, check out
uwhealth.org/diabetes.
Follow-up Care
Appointments [138075]
Schedule Appointment [NURCOM0056] Routine
Reason for Follow-Up: Diabetes Self Management
Training
With whom: Diabetes Clinic
For When:
Schedule Appointment [NURCOM0056] Routine
Reason for Follow-Up: Diabetes Self-Management
Education/Support
With whom:
For When:
Follow Up Appointments - Diabetes (Single Response) [149021]
Joint Commission Requirement: Patients must have an appointment scheduled WITHIN 30
DAYS of discharge with a provider who will manage their diabetes care. Exclusions are allowed
based upon patient situation (e.g., discharge to skilled nursing facility, patient refusal, etc.).
Schedule Appointment with Provider to Manage
Diabetes [222085]
Schedule Appointment [NURCOM0026] Reason for Hospital Follow Up Appointment:
Diabetes management
Which Provider:
Page 3 of 6
Printed by SPENCER, LINDSEY M [LMS033] at 8/1/2017 5:26:27 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Appointment scheduled (with provider who can
manage diabetes) [COR0064]
ONCE For 1 Occurrences, Routine
Documentation (required): Appointment scheduled
(with provider who can manage diabetes)
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with
a provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is
a Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient
refusal, etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed
to request assistance in scheduling an appointment.
Appointment scheduled per patient report
(ENTER DATE IN COMMENTS) [COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): Appointment scheduled per
patient report (ENTER DATE)
Date of appointment (Month/Year):
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Appointment pending: patient discharged on
weekend; follow-up information provided
[COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): Appointment pending:
patient discharged on weekend; follow-up information
provided
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Page 4 of 6
Printed by SPENCER, LINDSEY M [LMS033] at 8/1/2017 5:26:27 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Free clinic information provided [COR0064] ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): Free clinic information
provided
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
No appointment: Patient discharging to a facility
(e.g., skilled nursing facility, correctional facility,
etc.) [COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): No appointment: Patient
discharging to a facility (e.g., skilled nursing facility,
correctional facility, etc.)
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
No appointment: Patient refusal [COR0064] ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): No appointment: Patient
refusal
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Page 5 of 6
Printed by SPENCER, LINDSEY M [LMS033] at 8/1/2017 5:26:27 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

No appointment: Patient does not have diabetes
[COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): No appointment: Patient
does not have diabetes
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Page 6 of 6
Printed by SPENCER, LINDSEY M [LMS033] at 8/1/2017 5:26:27 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org